An attorney representing the mother of a five year old girl who was removed from her care at age two following severe sexual abuse by mother’s boyfriend, neglect and an assortment of other traumatic experiences all at the hands, or in the presence of, the mother asked me, “Why would you suggest that reunification could be an overwhelming experience for this child? I can understand it if the abuse occurs with an older child who remembers the abuse but with an infant? How can an infant possibly remember a traumatic event?”

After, biting my tongue and counting to ten, I tried to explain. And, in all fairness to this attorney, her ignorance about the nature of traumatic memory and development is shared by far too many responsible, well-educated and caring people. It is a common misperception that very young children are “so resilient” and often “unaware” of the nature of the traumatic experiences that they more capable of coping with trauma than adults. This is just not so. And in my role as a willing teacher to this misinformed attorney I attempted to explain this. A fair, but edited, version of my responses to this person’s questions about the impact of maltreatment on the infant follows.

How can an infant possibly recall a specific abusive event?

The key word in this question is "recall." Most people think of memory as limited to the storage and recall of cognitive, narrative memory. With this understanding, a pre-verbal infant would not be capable of "remembering" and "recalling" any event. And, of course, we are all familiar with the developmental amnesia that occurs at approximately age three. At about this age it is normal for the brain to essentially reorganize cognitive and memory functions such that narrative memory for events prior to age three or four are difficult to access later in life. These two points have led to the pervasive, inaccurate and destructive view that infants do not recall traumatic experience, including sexual abuse. Nothing could be further from the truth.

The human brain has multiple ways to "recall" experience. Indeed, the brain is designed to store and recall experience in multiple ways; we have motor, vestibular, emotional, social and cognitive memories. When you walk, play the piano, feel your heart race in an empty parking lot at night, feel calmed by the touch of a loved one or create a "first impression" after meeting someone for first time, you are using memory. All incoming sensory information creates neuronal patterns of activity that are compared against previously experienced and stored patterns. New patterns can create new memories. Yet the majority of these stored memory templates are based upon experiences that took place in early childhood (as I described a bit in my January column) – the time in life when these patterns of neuronal activity were first experienced and stored. And the majority of our 'memories' are non-cognitive and pre-verbal. It is the experiences of early childhood that create the foundational organization of neural systems that will be used for a lifetime.

This is why, contrary to popular perception, infants and young children are more vulnerable to traumatic stress – including sexual abuse. If the original experiences of the infant with primary caregiving adults involve fear, unpredictability, pain and abnormal genital sensations, neural organization in many key areas will be altered. For example, abnormal associations may be created between genital touch and fear, thereby laying the foundation for future problems in psychosexual development. Depending upon the specific nature of the abuse, the duration, the frequency and the time during development, a host of problems can result. In many ways, the long-term adverse effects of sexual abuse in infancy are the result of memories – physiological state memories, motor-vestibular memories and emotional memories, which in later years can be triggered by a host of cues that are pervasive.

Incestuous abuse in infancy is most destructive in this regard. It will result in the association of fear, pain and unpredictability into the very core of future human functioning – the primary relational templates. If these original 'templates' for all future relationships are corrupted by sexual exploitation and abuse, the child will have a lifetime of difficulties with intimacy, trust, touch and bonding – indeed the core elements of healthy development and functioning throughout the lifecycle will be altered.

Furthermore, if the child is sexually abused during early childhood, they may not have any cognitive "memory" and be completely unaware that the source of their fears, difficulties with intimacy and relationships has its roots in this betrayal in infancy. This can lead to problems with self-esteem and, will make any therapeutic efforts more difficult.

So abuse during infancy can impact cognitive, emotional or behavioral development?

Yes. The abuse of an infant is often accompanied by extreme disruptions of normal caregiving behaviors and by extreme and prolonged stress responses. Altered caregiving and a prolonged stress response will alter the development of the infant’s brain, which is, of course, the organ responsible for emotional, cognitive, social and physiological functioning. Furthermore, the primary caregivers are the source of the majority of emotional, cognitive and social experiences and therefore, the learning opportunities of the child during infancy. Development in all domains can be disrupted if these primary relationships are compromised. If the primary caregivers are abusive it is almost inevitable that emotional, behavioral and cognitive development will be arrested by early traumatic experience.

Are you saying that abuse in infancy impacts attachment?

Again, yes. The development of attachment and healthy socio-emotional functioning depends upon the presence of consistent, responsive, attuned and nurturing caregivers. One of the central tasks of these relationships is to keep the child safe. If these caregivers are unable to protect, or worse, if they participate in the abuse of the child, the core of all future relational interactions is corrupted. The distortions in attachment that result from abuse in infancy can be toxic to all future relationships. Again, the cascade of problems that result from impaired socio-emotional functioning due to early life sexual abuse can impact all domains of functioning and be a source of ongoing confusion and pain to anyone experiencing abuse in infancy.

Does abuse change the brain of the infant?

The brain is designed to change in response to experience. Indeed, all experience changes the brain. With traumatic experiences, the changes are in those parts of the brain involved in the stress and fear responses. Many studies with adults and, now with children, have demonstrated a host of neurophysiologic changes that are related to traumatic stress. More controlled studies are needed but there is no doubt that the major neurophysiological networks and neuroendocrine systems in the brain and the rest of the body are altered by developmental trauma.

Do infants have problems similar to older children who are abused?

The adverse effects that result from abuse will vary as a function of several keys factors: what is the nature of the abuse, the duration, frequency, intensity, time during development and the presence of attenuating factors such as other caring, attentive caregivers in the child's life. In general, however, with all traumatic experiences, the earlier in life, the less "specific" and more pervasive the resulting problems appear to be. For example, when traumatized as an adult, there is a specific increase in sympathetic nervous system reactivity when exposed to cues associated with the traumatic event. With young children, following traumatic stress, there appears to be a generalized increase in autonomic nervous system reactivity in addition to the cue-specific reactivity. Due to the sequential and functionally interdependent nature of development, traumatic disruption of the organization and functioning of neural system can result in a cascade of related disrupted development and dysfunction. Examples of this include the motor and language delays in traumatized children under age six. The "causes" of these delays are likely due to the primary, trauma-induced alterations in other domains (e.g., the stress response systems, thereby influencing physiological reactivity, hypervigilence, concentration), which, in turn, impair the young child's willingness to explore, capacity to process new information and ability to focus long enough on new information to learn.

The bottom line – all jargon aside – trauma during infancy has a profound impact on the developing child; and sadly, most traumatized infants end up “remembering” the trauma in one way or another for the rest of their lives.

Bruce D. Perry, M.D., Ph.D. is the Senior Fellow of The ChildTrauma Academy, a not-for-profit organization based in Houston that promotes innovations in service, research and education in child maltreatment and childhood trauma (www.ChildTrauma.org). Dr. Perry is the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog: What Traumatized Children Can Teach Us About Loss, Love and Healing, a popular book based on his work with children, published by Basic Books. Over the last twenty years, Dr. Perry has been an active teacher, clinician and researcher in children’s mental health and the neurosciences, holding a variety of academic positions.